Health Crisis Abroad, Part 2: Surgery

The day after my ER visit, I managed to get an appointment with the surgeon that my doctor recommended, Dr. Vitelli. Josh and I took a taxi to Clinica Mater Dei, a hospital way across town. I was fairly relieved to see how beautiful and modern and clean it was (after the ER experience, I was fearing the worst). We checked in, with some confusion - the administrator we spoke to said that the doctor was not in (even though we had an appointment), and that we'd have to wait for him.

I didn't panic, but I did worry that we'd taken an eighteen euro cab ride for nothing. After a short wait, though, the doctor himself came to collect us. He was quite tall, and my first impression of him (besides his quietly warm manner and firm handshake) was that he was impossible to keep up with. Of course, I was still feeling a great deal of pain, and had to sort of lurch after him. We took an elevator up to an office - but not his - and started to talk.

The short of it was that he believed that the gallbladder had to come out, and he said that he could do the surgery on Tuesday, with my intake on Monday. I was to stay at the hospital for three days. Usually, with such a routine surgery, people can be out of the hospital in 24 hours, but because of my anti/coagulation issues, they wanted to monitor me for longer. I was instructed to stop coumadin immediately and begin taking injections of heparin.

Mind whirling, we returned home and began to prepare. My mother-in-law, Candace, offered to come help us, and she arrived Monday morning. I received an outpouring of support from friends here at the Academy. Some people offered babysitting; some sent me books and magazines to read in the hospital; the head chef here even offered to make me special food since I was on a liquid diet. They were (are) all amazing.

Someone said to me on Sunday afternoon, "You're so calm!" I guess I was? I think in general, my emotions tend to manifest in big ways in the day-to-day. But when it's serious, I think I tend to rein them in. My main concern at that point, honestly, was Indigo. I sat her down a few times to explain that I was sick, and had to go to the hospital, but was going to be fine, and would be back in a few days. It was really important to me that her world be as untouched as possible - that her schedule remain the same, and so forth. I couldn't stop worrying about her, even though I was leaving her in the best hands: Josh and Candace.

Monday came, and off to the hospital we went. Josh came to get me settled in. I had a single room, which was really quite nice. "It's nicer than most hotel rooms in Europe," he remarked, which was true. I even had my own little balcony. After he left, I went through a battery of tests. I had an x-ray. An ultrasound of my gallbladder, liver and kidney. Later that afternoon, another ultrasound of all the points where I had previously had blood clots, to check and make sure that the blood flow was ok. I was jabbed with about 57 needles, and had an IV duct thing put in my hand. I saw the surgeon, the surgeon's assistant, an internal doctor, the anesthesiologist, and an array of nurses that fed me antibiotics, medication to protect my stomach, or took my blood pressure or give me a shot of heparin. I had my last meal; a very big lunch of pasta, potatoes, and steak (I was not allowed fruits or veggies).

And through it all, I was largely silent. The surgeon spoke perfect English, and the other doctors spoke some. A couple of the nurses knew enough (and I knew enough Italian) that we could sort of communicate. Sort of. But I existed on an English-speaking island for those three days, surrounded by an ocean of Italian - and it was very, very isolating. And lonely. I couldn't ask questions. I tried three times to call the number to get my Wi-fi password for my iPad, but could never understand what the person on the phone was saying. Even when a technician came to help me with the TV, they gave me the wrong information, and when I tried to get the correct information, I couldn't make myself understood. So I gave up. No internet or TV. Not a huge deal, since I had downloaded six books onto my iPad beforehand, but some contact with the English-speaking world would have been nice. I missed Indigo terribly. I cried, I missed her so much.

The very worst was right before surgery. I had been calm, for the most part, all day. A little anxious - mostly, it was hard to wait. Finally they came for me around 2:30. The nurses they sent for me spoke no English - they had to mime what I was to do to get ready. As I lay down on the stretcher wearing just a hospital gown I though, "Oh my god, this is it. What...?" but I couldn't ask anything. No one could tell me. When I'm nervous or feel out of control, I like to ask questions, or arm myself with as much information as possible. Do I seriously have to take of my rings? They're operating on the other side of my body!  I thought. Panic began to set in, and my heart was racing. Why is the operating room so cold? Is it to slow down my heart so that I don't bleed to death? They gave me something in my IV, and I almost instantly felt woozy. Presently I calmed, and felt a bit sleepy. At the time, I thought it was anesthesia, and worried that it wasn't working yet. Must keep eyes open. What if they think that I'm "out" and start cutting me open while I'm still awake?! I think now that they had probably given me some valium or something. They gave me something else and

...A slap. Another. "Ok, time to wake up," and another. Blearily I realized that the surgeon was slapping me awake. In another instant I realized that I was in horrible pain. I guessed it was over, then. I was suddenly in my room, and Josh was there. He was asking me something, but I literally could not form sentences. I got a few words out. I slept.

A few hours later I came to. I was still in terrible pain. Josh left, and that night was probably the worst night in memory. Labor was hard, and I was in pain afterwards, but it was nothing like this. I was not allowed to move off the bed, and I couldn't have, even if I had wanted to. There's a nerve that gets affected by the removal of the gallbladder, one that travels up the chest to the right shoulder. It throbbed in time with my heartbeat, and any little movement made it feel like a knife was being stabbed into my shoulder. I asked for painkillers a lot that night. Finally the nurses refused me (apologetically), saying that they had to "space the medicine out." I had a fever, but luckily a nurse opened the door for me, so that I could get some cool night air into the room. The muscles in my back screamed with tension, and because I could not shift my position for 16 or so hours.

But I got through it. The next day I was allowed to leave bed, and to eat some broth. The next day was even easier. I continued to live in a mostly-silent bubble. There was one nurse that I really liked; she was actually from South America, and Spanish was her native language. At one point she asked me a question in Spanish, and I answered her automatically, without realizing what language I had spoken. She was pleased (I suppose she could sympathize with being in a foreign country/speaking in a foreign tongue).

On the whole, I think the hospital experience was positive. Except for the communication factor, they took good care of me. I did have the sense that the staff cared, which is a big plus in their favor. I did feel at times, forgotten. I suppose that's to be expected, when I had absolutely minimal contact with anyone. I guess they would have come if I had kept buzzing for them, but I wasn't about to buzz them to my room just for a chat, even if I did speak the language. I've never had surgery before. Maybe you always feel isolated and alone? Frustrated? Lonely?

The other difficulty was the money. Our insurance pre-approved the surgery, but Mater Dei could not bill them directly. Which meant that we had to pay out-of-pocket...and file a claim to get reimbursed. The cost was staggering. It was a horrible shock. We had paid 4,000 euros when we checked in, which is what they charged for the surgery itself. But on check-out, we had to pay the balance, which included all the doctors' time, the tests, the room, every single itemized detail, down to the medication they gave me and the needles they used. We have the money, because we're building a house. But we need that money to build a house. So we're hoping and praying that we get our claim reimbursement before the contractor needs those funds. Or we're in big trouble. I don't know how we would have done this, if we hadn't been building a house. How do you pay big hospital bills in another country? If we said we couldn't pay it, would we have been arrested? No idea.

Not much more to say - I had a few painful days at home, but I was home. I was greeted by Indigo that first day yelling, "Mamamamamama!" and she climbed into my lap, and I didn't think of stopping her, even with the pain. I almost didn't recognize her. It had only been a few days but she looked...older. She wouldn't let me out of her sight for those first few days. I felt so grateful to be home.

And every day gets a little easier. As of today I am still tired and a little sore, but otherwise good. I got my stitches out. I have another week or so of giving myself injections before I can go back on coumadin, and a little longer before I'm really supposed to lift heavy things (ie, Indigo), and then I think I'm good. I feel better than I did pre-surgery, in a lot of ways. The surgeon said the gallbladder was so full of stuff and infected that it hadn't been working for some time, so I think I'd been sick for awhile. Hopefully the financial piece will get itself worked out, and then we can put this whole thing behind us.